Title: Bacteriological profile and antibiogram of surgical site infections - A study from a tertiary care teaching hospital of Kashmir Valley, India

Authors: Arshi Syed, Sheikh Mohd Saleem, Huma Majeed, Talat Masoodi, Syed Khursheed, Muzaffar Amin Mir, Amrish Kohli, Roomi Yusuf, Sumaira, Afreen

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.113

Abstract

Background: Postoperative wound infections, and now the surgical site infections (SSIs), they usually occur within 30 days following a surgical procedure and may occur up to 1 year if a prosthetic is implanted. In this study we aimed to determine the bacteriological profile and antibiogram of surgical site infections among patients attending a tertiary care teaching hospital.

Methods: The study was a cross-sectional study which was carried out at a tertiary care teaching hospital of Kashmir Valley. The study was conducted for a period of 2 months from November 2018-December 2018 among patients with SSIs from various surgical wards of the associated hospital. Patients with cellulitis and suture abscess were excluded. A questionnaire was developed before the study to capture socio-demographic and clinical details.

Results: A total of 55 swab samples were collected from different sites of the patients who had SSIs. The majority 29 (52.7) belonging to the age group of 21-40 years followed by 13 (23.6%) belonging to age group of < 20 years. Most of the subjects 30 (54.5%) were having normal body mass Index while 21 (38%) were obese. Most of the subjects 28 (50.9%) belonged to Upper Middle Class. Most of the samples 15 (27.3%) were sterile and were without any growth while 13 (23.6%) and 12 (21.8%) samples had growth of Staphylococcus aureus and E.Coli respectively. Most of the samples were sensitive to Imepenum 33 (60%), linezolid 31(56.4%), Amikacin 29 (52.7%) followed by Gentamycin 27 (49.1%). However, antibiotic resistance was seen for Ceftazidime clavulunate 36 (65.5%), Ceftriaxone 35 (63.6%), Pipercillin Tazobactum 31 (56.4%) followed by Cotrimoxazole 28 (50.9%).

Conclusion: Extremes of age and obesity are known risk factors for SSIs. Bacterial resistance is a serious threat for treating infections and exists for more commonly available and used antimicrobials.

Keywords: Bacterial Infection, Surgical Site Infections, SSIs, Wound Infection, Antibiotic Ressitance. 

References

  1. Awad SS, Palacio CH, Subramanian A., Byers PA, Abraham P, Lewis D, et al. Implementation of a methicillin resistant Staphylococcus aureus (MRSA) prevention bundle results in decreased MRSA surgical site infections. Am J Surg 2009; 198: 607-610.
  2. Negi V, Pal S, Juyal D, Sharma MK, Sharma N. Bacteriological profile of surgical site infections and their antibiogram: A study from resource constrained rural setting of Uttarakhand state, India. J Clin Diagnostic Res. 2015;9(10):DC17-DC20.
  3. Kelvens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care associated infections and deaths in U.S. hospitals. Public Health Rep 2007; 122: 160-166.
  4. Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect (Larchmt) 2002; 3(1): 9-21.
  5. Sheikh Mohd Saleem. Modified Kuppuswamy scale updated for year 2018. Indian J Res. 2018;7(3):6–7.
  6. MacFaddin   Biochemical  Tests  for  Identification  of  Medical  Bacteria.  3rded. Philadelphia: Lippincott Williams and Wilkins; 1976.
  7. Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott’s Diagnostic Microbiology.10th St. Louis, Misssouri, USA: Mosby Inc.; 1998.
  8. Clinical and Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing. Vol. 1, No.  1, M2 A9.  Pennsylvania, USA: Clinical and Laboratory Standard Institute; 2007
  9. Epidemiology-of-surgical-site-infection-in-adults - UpToDate [Internet]. [cited 2019 Mar 3]. Available from: https://www.uptodate.com/contents/search?search=epidemiology-of-surgical-site-infection-in-adults
  10. Young MH, Washer L, Malani PN. Surgical Site Infections in Older Adults. Drugs Aging. 2008;25(5):399–414.
  11. Santos MDLG, Teixeira RR, Diogo-Filho A. Surgical site infections in adults patients undergoing of clean and contaminated surgeries at a university brazilian hospital. Arq Gastroenterol. 2010;47(4):383–7.
  12. Thelwall S, Harrington P, Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery: Results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect [Internet]. 2015;21(11):1008.e1-1008.e8. Available from: http://dx.doi.org/10.1016/j.cmi.2015.07.003
  13. Anderson V, Chaboyer W, Gillespie B. The relationship between obesity and surgical site infections in women undergoing caesarean sections: An integrative review. Midwifery [Internet]. 2013;29(12):1331–8. Available from: http://dx.doi.org/10.1016/j.midw.2012.12.012
  14. Negi V, Pal S, Juyal D, Sharma MK, Sharma N. Bacteriological profile of surgical site infections and their antibiogram: A study from resource constrained rural setting of Uttarakhand state, India. J Clin Diagnostic Res. 2015;9(10):DC17-DC20.
  15. Windahl U, Bengtsson B, Nyman AK, Holst BS. The distribution of pathogens and their antimicrobial susceptibility patterns among canine surgical wound infections in Sweden in relation to different risk factors. Acta Vet Scand. 2015;57(1):11. Published 2015 Feb 28. doi:10.1186/s13028-015-0102-6
  16. Malik S, Gupta A, Singh PK, Agarwal J, Singh M. Antibiogram of aerobic bacterial isolates from post- operative wound infections at a tertiary care hospital in india.Journal of Infectious Diseases Antimicrobial Agents. 2011;28:45-51.
  17. Satyanarayana V, Prashanth HV, Basavaraj B, Kavyashree AN. Study of surgical site infections in abdominal surgeries. J Clin Diagn Res. 2011;5:935-39.
  18. Khan AKA, Rashed MR, Banu G. A Study on the Usage Pattern of antimicrobial agents for the prevention of surgical site infections (ssis) in a tertiary care teaching hospital. J Clin Diagn Res. 2013; 7(4):671-74.
  19. Chakarborty SP,  Mahapatra  SK,  Bal  M,  Roy    Isolation  and  identification  of vancomycin resistant Staphylococcus aureus from postoperative pus sample. Al Ameen J Med Sci. 2011; 4(2):152-68.

Corresponding Author

Sheikh Mohd Saleem

Demonstrator, Department of Community Medicine, Government Medical College, Srinagar, J&K